SAVING WRECKED LIMBS.

Taranaki Daily News, 24 April 1919, Page 6

SAVING WRECKED LIMBS.

WORK AT CHALMERS HOSPITAL. ORTHOPAEDIC TREATMENT DESCRIBED, Wellington, April 19. New Zealand's disabled soldiers are coming home rapidly, and their presence vividly reminds us that we still have a great war responsibility This, of course, must be largely shouldered by the State, and it will be a source of real satisfaction to the people of New Zealand to know that their Defence Department has brought to the Dominion the very best surgical and nursing skill (eyereised by New Zealanderß who have had special opportunities for training), and the latest appliances for the splendid work of lessening the disabilities of our wounded men.

Chalmers Military Hospital at Christchurch in charge of Colonel D. S. Wylie is an example of the remarkable developments in surgical science under the stimulus of war experience. This threestoried building, with its spaciouß wards and sunny verandahs, standing in the garden grounds of Christchurch public hospital, has • 130 patients who need orthopaedic treatment. Close to the Chalmers Memorial Ward is a new twostoried building which will soon give accommodation for another hundred patients, while a business arrangement with the Y.M.C.A. enabled 50 more disabled men to have comfortable board at the expense of the Defence Department while they receive treatment in the orthopaedic hospital. A few hours spent in the institution watching its humane activities aroused in the writer a keen sympathy for the fine soldiers who, in many instances, will carry their war burden with them to the grave; and an equally keen appreciation of the resources provided to lessen theit handicap. One sees here the hateful results of war, softened by the alleviating measures, though some of the bone, muscle and nerve injuries are so severe that orthopaedics—which is not miracle-working but good eurgery carefully followed up with common sense methods —can only reduce, and not completely cure the disabilities. A man's limbs may be badly lacerated by shell i fragments, a bone smashed, nerves sev-1 ered, and muscles torn. He has first to recover from the shock, the wound has to heal and the bone be replaced. Though this may be done successfully he is still incapacitated, for the function of the limbs may not be completely restored. This is where the development of orthopaedic surgery comes to the soldier's aid.

One of the most powerful X-ray plants in New Zealand has been installed at Chalmers Hospital by the Defence Department. With the aid of the excellent negatives it secures, dislocated or fractured bones may be easily examined, and the surgeon enabled to operate on a clear diagnosis of what might be a most complicated injury. The operating theatre of the Christchurch Hospital is used for the surgical work. But the surgeon does not complete his work operating. He has to secure if possible the restoration of the original functions of the limb, and this is where the large majority of appliances and methods of a well-equipped institution, such as Chalmers Orthopaedic Hospital is i" tremendous value. ' ELECTRICAL TREATMENT. The muscles are there, but the owner might not be able to control them. If he went out into the world at this stage he would be helpless. He has to be shown that these muscles are still capable of movement, and here electrical treatment and massage has to be adopted. A good many false ideas prevail us to the use of electricity as a curative medium. It has limitations, and the orthopaedist pretends to no "black magic" in his use of the current. Normally, muscle movement is controlled by the nerves, but lesion of these sensitive controls destroys the power of conveying to them the impulses from the brain. A patient in this condition goes to the massage room for attention.at the hands of the trained New Zealand women who have been selected because of their experience of the latest English methods. They use the British War Office standard electrical table, which is splendidly deaigned to secure simplicity and thorough control. The patient lies in the massage couch, his injured limb bared, and resting on a wet pad—a good conductor of electricity. The masseuse tests the extent of his muscle control, and from her intimate knowledge, reinforced with the data provided by the surgeon, "picks up" the muscles uncontrollable and dormant. At her side a metronome ticks quietly, plunging an electrical contact into a mercury bath at each swing, sending current to two pads manipulated by the operator. In rythmic succession the current is alternately applied and released. The effect on the muscle is remarkable to the layman's eye. The patient cannot move it, but he feels the faradic current, and he also finds that the muscle he cannot control is contracted when the current is on. As the metronome releases the current the muscle relaxes—and so the process of contraction and relaxation goes on, demonstrating that when the nerve comes again into action (and this is helping to that end) the muscle will once more come under the control of its owner's brain. The whole process is stimulating to muscle and nerve, and though it may take many months, normal control comes back at length, and the soldier blesses the resources which science provides to lift him out of his helplessness.

Ordinary massage is also given where required, and another interesting feature of this department is the muscle re-education conducted by the staff. Perhaps a man's right arm 'is not functioning properly, though his left is normal. So the masseuse handles the right arm, gets the soldier to slowly exercise the muscles of the left while, with her aid, the deficient limb is made to follow the same movements. And gradually the defective muscles commence to resume their functions under this practical educative process. The wide range of cases under the excellence of the equipment at Chalmers Hospital affords a good opportunity for training masseuses, 25 of whom are undergoing a course of instructios by a staff which has had experience in English orthopaedic hospitals. Thus the requirements of other hospitals of the kind in New Zealand will be maintained. WHIRLPOOL AND AERATED BATHS. A valuable adjunct to the massage department is the specially equipped bathroom, where many of the patients have a preliminary course of treatment in whirlpool and aerated baths. Legs or arms are immersed in specially designed baths, while an electrically driven, turbine in the bottom stirs up an artifisiaj whirlfML. wd as an ra-

source, the attendant can set the whole bath bubbling violently with compressed ai' This treatment has a valuable effect in softening the skin and improving the circulatory system before massage. The masseuse often has to do her work at the bath, as more movement of an injured limb is often possible under water, with the stimulating effect of aeration aim the whirlpool. ORTHOPAEDIC GYMNASTICS. But orthopaedic treatment does not end with these things. It has many phases, all bearing on the one great Aject, the restoration on function of the injured parts of the body. The soldier cannot be constantly in the bath, nor can he get continuous massage. Something more than spasmodic treatment is necessary, consequently the orthopaedic gymnasium and the curative workshops form an essential part of the system. In the gymnasium carefully designed exercises are carried out by small squads of men with similar disabilities, inducing them to use their deficient muscles and restore full control. Many of them, as a result of long disability, are very chary of activity, but the knowledge that their instructor is trained in this branch of gymnastics, and that behind him is the advice of the surgeon, gives the men confidence Tliey attempt movements which they thought impossible—and they succeed. When the set exercises are over the class plays a round game well within physical capacity, and in the excitement of competition the cautious ones do things they would not cold-bloodedly essay—and another step has been made in the restoration of function. A mirrow facing a walking track is one of the fittings. This enables a man to correct mistakes in his gait which have been brought on by injury. He sees his awkwardness, is told how to correct it, and gradually gets back the poise and balance which will reduce the outward signs of his disability.

IN THE WORKSHOPS. It is in the workshops that the most constant development of deficient functions can take place. Massage, baths and gymnastics can necessarily fill only a part of the day, but in the workshops the soldier may put in some hours of useful work—doubly useful for the reason that the output has an economic value, and in securing it the soldier helps to cure himself. Thirty men attend the carpenters' shop daily. Their principal work just now is the making of massage conches for the New Zealand orthopaedic hospitals. The knowledge that they are doing useful work stimulates their interest, and the task set for them, steadily pursued, helps them to regain control of the limbs and facility in their use. Men who were once right-handed are sometimes obliged to train the left hand to a wider range of duty so as to make up for deficiencies. Then they find the carpentery an interesting means to that end. It is the same in the leather-work and basketmaking shops, which are very useful in the numerous cases of hand injuries. Stiff-moving fingers are applied to these delicate hand operations, and under the direction of skilled and sympathetic women instructors, the patients are encouraged to persist in work which helps to bring back their old facility of movement and strength of fingers.

IMPROVEMENT IN SPLINTS.

The making of splints and surgical appliances is an important activity at Chalmers Hospital, and it is evident that this art has developed enormously during the last few years. We see nothing of cumbrous wooden splints, because sheet-iron and aluminium are now the principal materials. Splints can be shaped to fit and to gently correct almost any deformity, The iron-workers, who have an airy, well-equipped shop, include specially trained men who were selected by Colonel Wylie from among the New Zealanders who gained experience in England. Men are being'trained here for splint work in other New Zealand orthopaedic hospitals, and a number of 'the patients also gain benefit from the handling of the tools and machines. The finished splints are faced with soft lint, making them very comfortable and neat. Their variety is infinite, corresponding to t1» nnfortunately large range of injuries which men receive in modern warfare. "Drop foot" and "drop hands" are familiar signs of the cripple, and it is pleasant to note how the splint designer gives improved appliances to help men suffering from these troubles. For the "drop foot" patient there is a splint with spring attachments to the leg which gives the foot strong but elastic support, encouraging the patient to use the foot until, with the help of the splint and other orthopaedic treatment he can regain the use of the lower muscles and walk without a crutch. A more elaborate splint on the same principle, with the fingers attached to spring loops working from the fore-arm, gives an artificial grip to an otherwise helpless hand, thus assisting to pave the way to normal muscular control.

Plaster splints have also to be used, as this is the most suitable medium for some deformities which are the result of nerve lesion. These splints, made by English trained experts, are particularly fine pieces of work in which strength and economy of material (for the sake ot the patient's comfort) are cleverly blended. This department makes a plaster east of deformed limbs, as a record of the patient's original condition. A collection of these casts already constitutes a "war museum" which will preserve for posterity, vivid evidence of what war means to the men who risk their lives for their country. As it is often impossible to get a limb back to its original shape, the art of the bootmaker has to be applied to surgical boots. This is another department in the busy hospital. A shortening oi the leg up to one inch.can usually be concealed by a well-made surgical boot, but some of the shortenings are three inches, which necessitates building up the sole in visible (ashion. Many books have been written on this interesting subject of orthopaedic surgery, and as the Chalmers Hospital embodies all its features, one would have to go a long way beyond the length of newspaper articles to do justice to all the work. We have no space in which to deal, for instance, with the valuable assistance of vocational training which aims at interesting the soldier in his civilian future, and encouraging him to make practical preparations for it. What is to be seen at the Chalmers Hospital is a development of surgery which will be of the utmost value to civilians as well as soldiers, because these modern appliances imported by the Defence Department for its own purposes will demonstrate their value in general hospital practice, and will tend to become part of the standard equipment of every public hospital.